Summary Background Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. Methods We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602. Findings Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1·34 years [IQR 0·19–2·44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1·35 (95% CI 1·20–1·50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2·45 (1·82–3·29) for intracranial haemorrhage and 1·23 (1·08–1·40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4·55 [95% CI 3·08–6·72] for intracranial haemorrhage vs 1·47 [1·19–1·80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5·52 [3·36–9·05] vs 1·43 [1·07–1·91]; and for ≥20 cerebral microbleeds, aHR 8·61 [4·69–15·81] vs 1·86 [1·23–2·82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48–84] per 1000 patient-years vs 27 intracranial haemorrhages [17–41] per 10...

The use of 1.0-mol/L gadolinium chelate enables us to detect an increased number of enhancing lesions and patients with active disease. A delay of 5 minutes after the injection of the gadolinium chelate might be sufficient to detect active lesions in patients with MS.

AIm:To compare anterior pituitary functions between subjects with total and partial primary empty sella (PES) and to assess whether all cases with PES need endocrinological evaluation. mATERIAL and mETHods: Eighty-one subjects with PES (34 total and 47 partial) were included in the study. Basal anterior pituitary and its target hormones were assessed and those with low insulin like growth factor-1 and/or low basal cortisol levels underwent insulin tolerance test (ITT).REsuLTs: 67.4% of the subjects with total and 14.9% of those with partial PES had different degrees of hypopituitarism. However, the frequency of hypopituitarism was significantly higher in cases with total PES. The odds ratio (OR) and 95% confidence interval (CI) of secondary hypothyroidism, secondary adrenal, growth hormone and gonadotropin deficiency in subjects with total compared to those with partial PES were as follows: OR = 20.0, 95% CI 4.16 -95.9, OR = 2.4, 95% CI 1.34 -5.7, OR = 15.3, 95% CI 4.48 -52.6 and OR = 10.6, 95% CI 3.37 -33.5, respectively. CoNCLusIoN:A substantial number of subjects with PES, particularly those with total PES, have pituitary hormone deficiency, so regardless of the type of PES, all subjects must be promptly and carefully evaluated for anterior pituitary hormone deficiency.KEywoRds: Primary empty sella, Hypopituitarism, Clinical evaluation, MRI ÖZ AmAÇ: Bu çalışmada parsiyel ve total primer boş sella (PBS) olguları arasında ön hipofiz fonksiyonları bakımından karşılaştırma yapılması ve tüm olgularda endokrinolojik değerlendirme gerekliliğinin saptanması amaçlanmıştır. yÖNTEm ve GEREÇLER: PBS tanısı konan 81 olgu (34 total ve 47 parsiyel) çalışmaya dahil edildi. Tüm olguların bazal ön hipofiz ve bunların hedef hormonlarının düzeylerine bakıldı, insülin benzeri büyüme faktörü-1 ve/veya bazal kortizol düzeyi düşük olan olgulara insülin tolerans testi (İTT) uygulandı.BuLGuLAR: Total PBS'sı olan olguların % 67,4'ü ve parsiyel PBS'sı olan olguların %14,9'unda değişik düzeylerde hipopituitarizm saptandı. Ancak total PBS'sı olan olgularda hipopituitarizm belirgin olarak daha yüksek bulundu. Sekonder hipotiroidizm, sekonder adrenal yetmezlik, büyüme hormonu ve gonadotropin eksikliklerinin total PBS'sı olan olgularda parsiyel PBS'sı olan olgulara kıyasla odds oranları (OR) ve %95 güven aralıkları (%95 GA) sırasıyla OR = 20,0; %95 GA 4,9;OR = 2,4; %95 GA 1,7;OR = 15,3; %95 GA 4,[48][49][50][51][52]6 ve OR = 10,6; %95 GA 3,37 -33,5 bulundu. soNuÇ: Bu çalışmanın sonuçları özellikle total PBS'sı olan olgular olmak üzere PBS'sı olan olguların önemli bir kısmında değişik düzeylerde hipopituitarizmin varlığını göstermektedir. Bu nedenle PBS'nın tipine bakılmaksızın tüm olgular ön hipofiz hormon yetmezliği bakımından en kısa sürede uygun bir şekilde değerlendirilmelidirler.ANAHTAR sÖZCÜKLER: Primer boş sella, Hipopituitarizm, Klinik değerlendirme, MRG

Research in context panel: 445Identifying people at highest risk of ICH may facilitate timely and accurate prognostication to allow mitigation of reversible risk factors for bleeding (e.g. intensive blood pressure control), and selection of participants for clinical trials. While more complex combinations of clinical, biochemical, and radiological markers might further improve stroke risk prediction, balancing accuracy with simplicity will remain important.

Background and Purpose-Cerebral microbleeds (CMBs) are known to be indicative of bleeding prone microangiopathy.Little is known about its significance in anticoagulated patients. We aimed to determine the frequency of CMBs in ischemic stroke patients on warfarin treatment. Methods-A total of 141 ischemic stroke patients on warfarin therapy were enrolled in this study. One hundred five patients with similar demographic features who do not use warfarin were chosen as controls. We compared vascular risk factors and radiological findings including CMBs and leukoaraiosis between the groups. Results-CMBs on gradient-echo MRI (GE-MRI) were found in 31 patients (22%) and 17 controls (16%) and there was not a significant difference between 2 groups (Pϭ0.25). Study patients with CMBs were older than patients without CMBs (Pϭ0.04) and frequency of leukoaraiosis was significantly higher (Pϭ0.008). Mean duration of warfarin treatment was not different between the patients with and without CMBs (Pϭ0.83). Conclusion-Although